Accuracy and repeatability of cementless total hip replacement surgery in patients with deformed anatomies.

The present study is aimed to assess the repeatability of orthopaedic surgeons in planning total hip replacement surgery, and the Planned-vs.-Achieved accuracy obtainable with a conventional unassisted surgical procedure. A CT-based surgical planning system called Hip-Op was used for pre-operative planning the pose of the cementless components. The study group included only patients affected by severe deformities of the hip joint. In the repeatability study three surgeons were asked to repetitively plan the same three cases in a blind way. There was agreement among surgeons and also consistency for each surgeon in planning the implant position, while the most expert surgeon was more repeatable in planning the implant orientation. For all patients of the study group, the Planned-vs.-Achieved accuracy was computed as the difference between the spatial position of both prosthetic components derived from the post-operative CT scans and that achieved by the surgeon in the pre-operative planning. The average differences for the stem were lower than 5 mm for the position, and lower than 5 degrees for the orientation. For the socket the average differences increased to 8 mm and 10 degrees. The study shows the need for a more informative planning environment and for intra-operative supports, especially when deformed anatomies are involved.

A new method to compare planned and achieved position of an orthopaedic implant.

The present study describes an automatic method to evaluate the efficacy of a computer aided orthopaedic surgery system by comparing the position of the joint implant, as derived from post-operative computed tomography (CT) scans, to that planned by the surgeon before the operation. The method relies on two spatial registrations, one to align the post-operative femur with the pre-operative femur, the second to compute the planned versus achieved (PVA) accuracy as the roto-translation that registers the pre-operative implant position with the post-operative position. Two surface registration algorithms (a generic average distance minimisation and the specialised iterative closest point (ICP) method) were comparatively evaluated first on a set of test cases to measure the absolute accuracy and robustness with respect to peculiar situations such as a distant starting point. The average distance method failed the registration of one test case and showed peak errors of 0.97 degrees on the rotations and 3.09 mm on the translations. The ICP method was found much more efficient and was able to register all test cases. The peak error was 0.44 degrees on the rotations and 0.67 mm on the translations. The ICP method was then used to compute the PVA accuracy on six clinical cases treated with a CT-based planning system in combination with conventional surgical procedures. The method successfully processed all cases demonstrating the efficacy of the proposed procedure in the specific application.